CAMH’s Addiction Medicine Service adds outpatient detox option

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TORONTO, November 17, 2016 - ​Omar is holding it together. He’s working 12-hour days running a successful small business – and continuing to drink a 26-ounce bottle of rum every day. He starts with a quick triple at work each afternoon, and ends with a nightcap at midnight. He knows it can’t last. His family doctor has told him his liver is at high risk for permanent damage. But every time Omar tries to cut back, he gets tremors and headaches -- symptoms of alcohol withdrawal.

Elisa is a single mom with two young children. She’s waitressing to cover her rent and put food on the table. She doesn’t have much left over for other basics. Her mom helps out with some child care. Elisa drinks throughout her work shifts. Her oldest daughter was scared after seeing her mom intoxicated recently. After that incident, Elise tried going cold turkey, but the withdrawal symptoms caused a seizure. She’s terrified about having another one -- and even more so that her kids might be taken away from her.

People like Omar and Elisa are benefiting from a new Ambulatory Withdrawal Service (Day Detox) introduced by the Addiction Medicine Service at CAMH this summer.

It’s an outpatient withdrawal service – think day surgery -- providing a new option for patients who want to stop drinking or using opiates.

“We have many clients who are not able to take a week away from family or work responsibilities for an inpatient detox program but know they must address their drinking or opioid use,” says Shannon Greene, CAMH’s Addiction Medicine Service (AMS) Manager. “They’re physically dependent on alcohol or opioids. They’ve tried to cut down or quit, but can’t.”

Shannon Greene

The addition of the Day Detox to AMS services “fills a gap and provides an important entry point for these clients to address their drinking or opiate use,” she says. “This is a comfortable and safe place where they can start a medically-managed withdrawal and get initiated on appropriate medication.”

The service, located at CAMH’s Queen Street site, is currently serving 5 to 10 clients each week and has capacity for up to approximately 500 per year, says CAMH Advanced Practice Nurse Alison Watson, who supports this new AMS program.

Nurse Practitioner Kari Van Camp (left) and Advanced Practice Nurse Alison Watson are part of the AMS team supporting the new Day Detox option

Patients are referred through CAMH’s Emergency Department, Access CAMH service, and programs such as the Metro Addiction Assessment and Referral Service (MAARS). “The new Day Detox is a really important part of our continuum of services,” says Alison. Many patients receive a ‘warm transfer’ from the CAMH Emergency Department based on clinical teamwork across the two areas – “that builds on the momentum for change that is so important.”

Alison describes the new Day Detox service, through the eyes of Omar:

He stops consuming alcohol by 6 p.m. the previous evening, based on instructions from the AMS

Omar arrives at 8:30 a.m. at the CAMH Day Detox, experiencing withdrawal symptoms

Omar is welcomed by a Registered Nurse and assigned one of three comfortable day beds in a newly renovated clinic

Nurses assess Omar and work with a physician to start him on a medication to ease his withdrawal symptoms

He’s assessed by clinic physicians and nurses throughout the day – and receives medication and support tailored to the severity of his symptoms

Omar’s spouse, Mariam, arrives to pick him up at 3 p.m. and drive him home, with specific instructions for what to do if Omar’s condition worsens

Clinic staff ask Omar to return the next day for a follow-up assessment and to discuss his relapse-prevention plan

Omar receives some additional medication, including an anti-craving medication, to get him through the following weeks and months

Omar is referred to a short-term group in the AMS and given some contacts in the community to connect with, to support his long-term recovery.

Back at work in his small business, he books an appointment at CAMH for the next month to visit the clinic and check his health and progress.

In addition to supporting clients with their alcohol withdrawal, the Day Detox is also used to stabilize clients with opioid use disorders by initiating opioid substitution therapy such as Suboxone.

Shannon notes that follow-up evaluations of the new Day Detox service are being planned. This may include 6-month follow-ups with clients, along with a review of program utilization and medication levels, to ensure continued effectiveness.

“We’re excited about how this service provides a new intensive outpatient option to help our clients deal with their drinking and opiate use,” she says.

Note: Omar and Elisa’s challenges are real – their names and stories are composites of many clients now receiving care in CAMH’s Day Detox program.